Provider Demographics
NPI:1215178835
Name:PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C.
Entity Type:Organization
Organization Name:PACIFIC CATARACT AND LASER INSTITUTE, INC., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:AUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-242-3008
Mailing Address - Street 1:115 NEW VIEW COURT NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506
Mailing Address - Country:US
Mailing Address - Phone:360-242-4610
Mailing Address - Fax:360-807-7687
Practice Address - Street 1:115 NEW VIEW COURT NE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506
Practice Address - Country:US
Practice Address - Phone:360-242-3008
Practice Address - Fax:360-807-7687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
WAASFFS60101112261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG001056800Medicare UPIN
WAG8895424Medicare UPIN